A letter to Congressman David Trott, Michigan’s 11th Congressional District:

January 15, 2017

I was disappointed that you did not attend the Save Our Health Care rally event at Macomb Community College in Warren today, Sunday, January 15, 2017. Several thousand Michiganders were present, including myself and many others from your District, along with several of your colleagues from the House of Representatives.

It is imperative that you OPPOSE efforts to repeal the PPACA. This should go without saying if there is nothing to replace it. But even if there is a replacement plan, a repeal introduces chaos and uncertainty into the health care marketplace for insurers, providers, patients and payers all. How do we plan? How do we protect ourselves, our families? What can we depend on?

Repeal is what you do with something that is doing more harm than good, or something that is doing no good at all. I’m certain that you know that the PPACA has brought good for millions of Americans since it took effect in 2010, including hundreds of thousands in Michigan and thousands in the 11th District. I don’t just mean those on Medicaid, though there are thousands who’ve benefited from that. I don’t just mean those who qualified for subsidies, though there are thousands who’ve benefited from that. I don’t just mean those with Medicare, though Medicare’s viability has been extended through the PPACA. I don’t just mean those who’ve seen their Plan D coverage improved, though there are thousands of those who’ve enjoyed that benefit.

I also mean those who’ve been encouraged to avoid health problems, because of wellness care and preventive care that is incorporated into PPACA.

I also mean those who’ve finally stepped up to paying a fair share into Medicare, through the added taxes that PPACA applied to those most able to afford them.

I also mean the balance that has been brought into the insurance companies through the Medical Loss Ratio that PPACA mandates — a provision that makes the insurance market more competitive and also makes health care cost more manageable for the patients.

I also mean the health care exchanges which simplified shopping for health insurance for the many millions who entered the market for the first time in their lives.

I know many people — some friends, some strangers looking for help, some as close as my own family — who have benefited from PPACA. For some of them, the benefit is measured not just in dollars — it is measured in better health, in early discovery and treatment of unknown ailments, in longer and better lives.

Beyond all of these direct benefits that PPACA has brought, there are several other reasons for preserving PPACA. These apply specifically to Michigan.

In Michigan,what had once been our “insurer of last resort” — Blue Cross Blue Shield of Michigan — no longer exists. Because PPACA was taking effect, the state legislature, guided by Governor Snyder, pushed to convert BCBSM from a state-chartered preferentially-treated insurer bound by “guaranteed issue” obligations into a mutual company subject to free competition in the marketplace. If PPACA is repealed, the “guaranteed issue” provision will go with it — and those who are “uninsurable” because of pre-existing conditions will find themselves abandoned again, as they were before PPACA.

In Michigan, what has been the SCHIPS program — “MIChild”, providing healthcare for low-income children — was effectively replaced, when PPACA brought about the Medicaid expansion. MIChild no longer exists. But if PPACA is repealed, the Medicaid expansion will be repealed as well — leaving Michigan’s most in-need children without access to healthcare.

PPACA is a large, far-reaching and complex program, in much the same way that the health care industry is a large, far-reaching and complex industry. In its first rendition, born as it was out of many political and financial compromises, PPACA is imperfect in several respects. Certainly, PPACA can and should be improved, its defects can and should be repaired, its reach can and should be extended, its cost-control mechanisms can and should be more effective.

But the underlying principle of PPACA is this — that we do not live as individuals in isolation from each other. We live in a unified society, where each of us is dependent in some way on and for others. When we formed this country, we shaped a government using the words “We, the People” — not “I, the Person”. In writing these words, we committed to looking out for each other, to forming a united society in which we all contribute so that we all survive, so that we all can enjoy the fruits of our nation. That principle is expressed in PPACA, where those of greater means, and even those of average means, are called on to contribute so those of the least means are not abandoned when it comes to good health care. To that end, some of us are paying more taxes than we would otherwise have. Some are paying higher premiums. Some are seeing new doctors. Yes, these are sacrifices — but for every person who is paying some small sacrifice, there are others — maybe many others — who are gaining life-saving benefits.

That’s what we are called on to do as Americans. Because being an American means that each of us is committed to the People, not just to ourselves. We are willing to sacrifice in some small way — some dollars, some change — so that We the People, as a People, all benefit.

You should fight against any effort to repeal PPACA. Fight to improve it. Fight to better it. Fight to expand it. But fight hard against repeal. Too many have benefited. Too many would be hurt.